IMIT STRATEGIC PLANNING

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IM/IT STRATEGIC PLANNING

• Health Informatics Workshop
• July 19-23, 1999
• Roger Girard

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WHAT IS STRATEGIC PLANNING?
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Strategic planning

• its all about making choices of what to do with
  limited funds
• Ensuring linkage with the Business Goals
• Importance of engaging clients in the process
• Support organizations
• Care providers
• Nursing
• Physicians
• Community-based resources
• Linkages with partners

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Myron Magnet (Fortune, June 27, 1994)

• Computers have not contributed (much) to
  productivity in past 40 years
• Tight centralized structures restrains
  productivity rather than liberating it
• I.T. should be decentralized to local managers

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CRHA IMSP CONTENTS
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VISION The Calgary Regional Health Authority
will have the reputation as a leader in the
healthcare industry for world-class innovation in
information management and technology. MISSION O
ur mission is to support decision-making by
enabling the delivery of information to our
clients.
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• CRHA IM VALUE CHAIN
• (based on Porter's value chain model)

Human Resources Management
Procurement and Materiel Management

Financial Management
Internal Value
Information Resources Management
Bio-Medical Technology Management
Value to society
Clinical Research


Value to students
Teaching


In-Bound Logistics
Investigation
Diagnosis
Treatment
Follow-up
External Value
References Consults Screening Community Physicians
Hospitals
Value to patients






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Business requirements are driven from the general
(ESD) to the specific (Business Plans). The
IM/ITS response to the business requirements
(expressed as goals and objectives) is influenced
by business priority in balance with information
technology advancements (emerging technologies),
deployment opportunity, resource constraints, and
service level commitments.
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• Benchmarking

• It is very difficult to do but it must be done
  I.T. is a very visible cost that is difficult to
  justify
• "Me too" or "My needs"?
• Do you need to be an original?
• Model Best Practices

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• McGill Hospital Survey

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• McGill Hospital Survey

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ATHENAS TEMPLE
DECISION SUPPORTPlanning, Utilization
Management and Clinical Decision Support
lt---Corporate Strategic---gt
Interfaces
lt---Departmental Support Systems---gt
Other client-based programs
Community-based and Home Care
Population Health
Acute Care Systems
Interfaces(on-line)
CLIENT DATA REPOSITORY
CORPORATE SUPPORT FUNCTIONS Finance, Human
Resources, Materials, Facilities.
lt-Corporate Support Systems-gt
INFRASTRUCTURE Networks, Buildings, Processes,
Policies, Procedures.
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ATHENAS TEMPLE External View - Common Foundation
Other Providers Community clinicians, U of C,
wellnet, Other RHAs, other
CRHA
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ATHENAS TEMPLE (Acute Care)
DECISION SUPPORTCorporate Data WarehouseOracle
Financial Analyzer
lt---Corporate Strategic---gt
Interfaces (batch)
Maternal newborn (Cygnet)
Labs and Micro (Cerner - CLS)
Health Records Abstracting (3M)
Nursing WMS (NMIS, Medicus)
Patient Placement (TDS, etc.)
lt---Departmental Support Systems---gt
Diagnostic Imaging (QuadRIS)
Heart Health EKG (Marquette)
Physio/OT/SW (Infomed)
Peds Anesthesia Monitoring
Orders and Results (TDS)
Operating Rooms (HBOC)
Transcription/Tracking (Sungard)
Maternal Newborn
Nutrition (CBORD)
PACS - D.I. (AGFA)
Dictating (Dictaphone)
Trauma (Trianalytics)
Pharmacy (BDM)
ICU (QMS, Tracer)
Scheduling (None)
Blood Bank (CLS)
Neonatal ICU
Pathology (CLS)
Renal (Diproton)
Mental Health
Interfaces(on-line) STC Datagate Interface Engine
CLINICAL DATA REPOSITORY Permanent Patient
Record (Eclipsys -TDS 7000), PHIS
CORPORATE / LEGACY SYSTEMS Payroll
(Computerease), Human Resources (Peoplesoft), GL,
Budgets, AP, Purchasing, AR, Fixed Assets
(Oracle), Inventory (Dynamed), Employee
Scheduling, Time and Attendance (TCT), Facilities
Management (Archibus), Food Management, Patient
Billing/AR (Tandem - needs replacement).
lt-Corporate Support Systems-gt
INFRASTRUCTURE Workstation and Network
standards, Microsoft Office, Web-site, Help Desk,
Firewall, V-Mail, Netscape Messaging
INFRASTRUCTURE WAN Networks, Connections to U of
C and Internet, State of LANs, Telemedicine,
Internal processes, Telecom, Policies and
procedures, Remote access.
Meets todays needs and will survive Y2K, capable
of being regional solution
Project currently being implemented that will be
a regional solution
Does not meet needs or Y2K, urgently needs
replacement
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ATHENAS TEMPLE (Community Health Resources)
DECISION SUPPORTUtilization Management and
Clinical Decision Support
lt---Corporate Strategic---gt
Interfaces (batch)
CRP
lt---Departmental Support Systems---gt
LTC - CIS
Clinical Access Databases
HCIS
CHIIS Replacement
SPRITS
Wellcom
Interfaces(on-line) STC Datagate Interface Engine
CLINICAL DATA REPOSITORY Permanent Patient
Record (Eclipsys -TDS 7000), PHIS
CORPORATE / LEGACY SYSTEMS Payroll
(Computerease), Human Resources (Peoplesoft), GL,
Budgets, AP, Purchasing, AR, Fixed Assets
(Oracle), Inventory (Dynamed), Employee
Scheduling, Time and Attendance (TCT), Facilities
Management (Archibus), Food Management, Patient
Billing/AR (Tandem - needs replacement).
lt-Corporate Support Systems-gt
INFRASTRUCTURE Workstation and Network
standards, Microsoft Office, Web-site, Help
Desk, Firewall, V-Mail, Netscape Messaging
INFRASTRUCTURE WAN Networks, Connections to U of
C and Internet, State of LANs, Telemedicine,
Internal processes, Telecom, Policies and
procedures, Remote access.
Meets todays needs and will survive Y2K, capable
of being regional solution
Project currently being implemented that will be
a regional solution
Does not meet needs or Y2K, urgently needs
replacement
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Information Management View
Information Technology View
User View
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• Outsourcing

• What is it... really?
• Depends more on what you have (or what you want)
  internally!
• Does it really permit savings?

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Business Support
Application Support
Operational Support
Building Blocks of ERP Systems Services (Source
Gartner Group)
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• Outsourcing Model

InsourcingZone
Strategic value of functionUtility
Strategic
OutsourcingZone
Low
HighEfficiency of internal vertical integration
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Portfolio of Relationships
Process CustomizationLow
High
Codified
ContextualExpertise
Source Dr. John Henderson, Boston University
School of Management
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A Key Requirement for Partnering Source Hubert
St. Onge, The Mutual Group

• Inter-dependence
• Not In-dependence
• Not Dependence

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• Lessons Learned from Outsourcing at McGill

• A quick transition was needed
• Is reversible... if you make sure it is! Focus on
  technology
• What was outsourced?
• Operations and technical support (X)
• Development (-)
• Help Desk (-)
• Application maintenance and support (-)
• Management (-)
• Networks LAN (-) and WAN (X)
• Implementation Installation (depends)
• Training (X)

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• Lessons Learned from Outsourcing at CRHA

• The issue Survival during Y2K
• Focus on services harder to reverse... high
  dependency on people and processes
• What was outsourced?
• Operations and technical support (X)
• Development (-)
• Help Desk (X)
• Application maintenance and support (X)
• Management (-)
• Networks LAN (X) and WAN (X)
• Implementation Installation (depends)
• Training (X)

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• QUESTIONS?
• COMMENTS?

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CRHA - Current Plans and Current Issues

• Health Informatics Workshop
• July 19-23, 1999
• Roger Girard

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OUTLINE

• ISSUES ACCORDING TO GARTNER GROUP
• CRHA KEY ISSUES
• MY KEY ISSUES
• SUSTAINABILITY OF ORGANIZATION
• SUSTAINABILITY OF INFRASTRUCTURE
• FINANCING
• CONCLUSION THREE KEY ISSUES

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• Financing ITS Options

• Depends on culture
• Ways to connect clients
• Charge-out (Zero IT budget)
• Budget allocations (Variable IT budget)
• Different solutions are possible
• Research
• Teaching
• Private
• Personal

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Funding Options

Decentralized
Centralized
I.T Credibility

---
Innovation

---
Savings

---
Satisfaction
???
???
Cost Control
---

Efficiency
---

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FUNDING

• Many sources
• Corporate, Departmental, Personal
• Teaching, Research, Private
• Budget pressure operational and capital
• Funding renewal and growth of infrastructure is a
  big problem
• Ministry funding rules
• Ability to borrow
• Ability to finance the depreciation of assets

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(No Transcript)
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• RVH Diagnostic Charge-out System

• Producing Departments (Lab, Radiology) establish
  a standard charge per product that is billed to
  the ordering department
• Purchasing Departments (Medical/Nursing
  departments) are allocated diagnostic services
  budget
• Purchasers are responsible for volume
• Producers are responsible for efficiency

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Healthcare IT Drivers and Strategies - Key Issues
for 1999Source Gartner Group

• How will evolving processes, relationships and
  business models change requirements for the use
  of IT in healthcare?
• The business of health is changing
• How will changes in regulatory, societal or
  technological arenas alter the importance or
  position of healthcare IT and the IS department?
• The healthcare environment is changing
• Should IM/IT follow or lead?

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Healthcare IT Drivers and Strategies - Key Issues
for 1999

• What applications and technologies will be
  needed, and when, in the rapidly changing and
  increasingly competitive healthcare environment?
• What methods, organizational structures and
  approaches are critical for healthcare to resolve
  the year 2000 problem?
• What organizational, management and strategic
  changes will healthcare organizations need to
  implement to realize greater value from IT
  investments?

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Key Issues for Healthcare IT Management in
1999Source Gartner Group

• Role and structure of the successful IS
  organization meeting requirements of evolving HCO
• Retention of IT skills and resources in an
  increasingly competitive healthcare and
  technology environment
• 7.5 qualified people fill 10 openings
• Aligning and deploying IT to realize value from
  increasing IT investments
• 2.8 of operating and 30 of capital
• Successfully managing the increasingly complex IT
  infrastructure and environment

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CRHA Key Issues

• Funding
• Sustainability of Operating Funds
• Renewal of Infrastructure (Capital)
• Partnerships with Primary Care providers
• Processes for making choices and being able to
  live with them

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MY KEY ISSUES

• Y2K (IT, CE and Facilities)
• Survive / leverage
• Delivery of major projects
• Engaging our clients
• Strategic planning
• Service levels
• Funding
• Sustainability of Infrastructure
• IT Costs and Accountability
• Financing Infrastructure Renewal and Growth
• Staff Retention
• Sustainability of Organization
• Stopping the pendulum
• Role of partnerships
• Making partnerships work
• Primary care providers
• Relationships with physicians
• alberta We//Net

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Sustainability of Organization

• The IT pendulum continues to swing
• Insourcing to Outsourcing and...
• CIO to CIO IT Pro to Clinician...
• IT to IM to IT
• Centralized to Decentralized to
• Control-oriented to Innovation-oriented
• We need to stop the pendulum if we are to have a
  sustainable approach

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Sustainability of Infrastructure
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ITS Expenditure Drivers
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Infrastructure Growth

• 4300 PCs can be expected to grow considerably in
  next 3-5 years doubling likely
• replacement of estimated 1000 dumb terminals by
  PCs
• Clinical Decision Support will require consistent
  access to terminals throughout region (every
  outpatient area, clinics, exam rooms, up to 12
  terminals to beds on inpatient areas)
• Managers will need access to terminals for
  e-mail, financial information, web-sites, policy
  manuals, etc.
• May not appear to be a problem today, but if we
  do not act before 2000/01 fiscal year,
  opportunity may be lost.

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Workstation Support Proposal
Support Costs
Evergreen
General/Help Desk 482
Software 100 (500 every 5 years)
Desktop 799
Hardware 400 (2000 / 5yrs)
1807 per workstation per year
898 per workstation per year
Break-Fix 138
Printers 75 (1500/4/5yrs)
Printers 58
Servers 80 (40000/100/ 5yrs
Servers 11
LAN 160 (800 / 5 years)
LAN 163
WAN 83 (2M / 4800 / 5yrs
WAN 156
2,705 per workstation allocated at budget time
1807 goes to ITS Operating Budget
898 goes to Evergreen Reserve
Note Telecommunications 239 per year per phone
handset for support
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Financial Issues

• Major part of IBM Agreement costs are not in
  operating budget
• These are operational activities that are
  required
• Funded by one-time money
• Containing costs of IBM contract and volumes are
  a constant challenge
• Infrastructure growth
• Client funds one-time cost and ITS must find
  operating dollars
• Pace of new projects is not decreasing as we had
  hoped
• Finding operating dollars from operational
  savings is a change in culture, and our means for
  harvesting savings and transferring costs are
  immature
• Transition from large Y2K Projects structure to
  sustainable Applications Support organization

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Financial Issues (contd)

• ITS Capitalization (3,492,000) from prior years,
  with depreciation not budgeted
• Harvesting infrastructure cost savings from
  efficiencies due to Y2K projects
• Will be difficult to harvest given growth and
  diseconomies of scale due to obsolescence factors
• Savings are not as much as thought since new
  systems are more complex and require more support
  than old ones
• Needed infrastructure growth to complete Y2K
  projects, examples
• TDS at RGH, ACH
• Network growth and redundancy
• Immunization
• OR Project
• Renewal of old infrastructure that survived Y2K
• Old TDS terminals at FMC, Networks at ACH/RGH,
  Telephone systems
• Projects Needing Funding
• HRIS, TDS, Ambulatory Care, PACs, Primary Care
• Y2K Funding Shortfall (6-11M)
• Plan to apply in round 2 of funding from Alberta
  Health

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ITS FIVE YEAR BUDGET (M) This projection is
based upon the plans contained mainly in section
9 of the draft Information Management Strategic
Plan. Please note that some of the budget figures
listed below are estimates only at this point,
and are presented as high-level estimates that,
in total, represent the "order of magnitude" of
the requirements. It is expected that these
estimates will be refined as we make strategic
decisions on the various options listed. Item
99/00 00/01
01/02 02/03 03/04 Base
Budget 16,288 16,288 16,288 16,288 16,288 IBM
contract costs - 10,700
10,700 10,700 10,700 Infrastructure
Renewal - 2,500 6,000
8,166 8,166 Infrastructure Growth
- 1,404 2,808 4,212
5,616 Support of Infrastructure Growth
(based on an estimate of 2,000 per year per new
workstation)
- 3,150 6,300
9,450 12,600 Growth due to new applications
(see following table)
- TBD TBD
TBD TBD Total
16,288 34,042 42,096
48,816 53,370 of Total CRHA budget 1.6
3.4 4.2 4.9
5.3 note that Health Care spends 2,
Education and Government and Insurance industries
currently spend 4, while Financial industry
spends 7 (US figures, according to Gartner
Group)
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STRATEGIC PROJECTS ITEM ONE-TIME COST
ONGOING COSTS Network VPN
500,000
100,000 Network
Redundancy
1,000,000
100,000 Decision Support System
2,000,000
300,000 TCT
Scheduling
3,000,000
600,000 HRIS
5,000,000

500,000 TDS-FMC - Renewal of terminals
1,500,000
0 TDS at RGH
5,000,000

100,000 TDS at ACH
5,000,000
100,000 Clinic
Scheduling
5,000,000
600,000 PACS (initial)
2,000,000

500,000 Community/PHIS
3,000,000
200,000 TOTAL
33,000,000

3,100,000
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Long Term Issues

• Managing Infrastructure Growth
• Need to have clients responsible for their
  decisions to add PCs, etc. via variable ITS
  budget and/or direct chargebacks not a popular
  move! Note that each net-new-PC costs CRHA (via
  ITS) over 1,300 extra per year in direct IBM
  costs alone, 2,000 overall
• Renewal of Infrastructure
• Formally recognize and account for cost of
  depreciation and replacement. This is needed
  otherwise service levels will drop or support
  costs will increase
• Organizational sustainability
• Can we afford to outsource as much as we do?
• Do we have the capability to insource? We
  didnt a few years ago why are we better today?
• A possible hybrid would be a CLS concept for
  ITS

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• QUESTIONS?
• COMMENTS?